L&D Teams Across Florida Hone C-Section Prevention Skills


Since early 2018, Florida Perinatal Quality Collaborative trainers have traveled the state teaching Labor Support Skills Workshops to promote primary vaginal deliveries to OB care providers.

During the FPQC Labor Support workshops, nurses, midwives and physicians, have an opportunity to learn evidence-based strategies to prevent cesarean sections.  A Certified Nurse-Midwife and Birth Doula team traverse the state far and wide to share this information at no cost.  Attendees learn from lecture, role-play, video, hands on practice and engaging discussion. 

Workshops have been held at 15 hospitals to date, training nearly 500 nurses over the course of a year and a half. The workshops are offered as part of the FPQC’s Promoting Primary Vaginal Deliveries (PROVIDE) Initiative, which seeks to reduce Florida’s cesarean section rate.

Each workshop is hosted by a PROVIDE partner hospital, but is attended by staff from a variety of hospitals.  This diversity in representation helps to create an interactive environment where nurses learn from each other.  It can be inspiring to know that the new strategy you have been considering is already working somewhere else.  

Nurses practicing hands-on comfort techniques

During the latent labor lecture, trainers highlight the newer definition of active labor because… 6 is the new 4!   Strategies to delay admission including shared-decision making, patient education tools, nurse to provider communication, and others are reviewed.   Addressing the value of continuous labor support and specifically partnering with doulas, provides an opportunity for engaging dialogue.

During the promoting labor progress and comfort measures lectures, we say “You’ve got to move it, move it”! After a review of the physiology of labor progress, we give specific examples of position that can be use to promote labor progress for laboring individuals with and without an epidural.  We specifically address the challenge of an occiput posterior presentation and positions used to facilitate rotation.   We then get out the birth balls, peanut balls, CUB device, rebozos, and the hospital bed to practice all of these techniques. 

Jessica Brumley, PhD, CNM, demonstrating second stage positions

A nurse from Tampa, FL who attended our event used a portion of the slides to teach all of the nurses in her unit during the mandatory education block time about position changes for the management of the occiput posterior fetus. She has personally championed the Miles Circuit, which has spread throughout the unit and contributed to a culture of frequent position changes in labor.

A nurse manager from Miami, FL shared that since attending the training they have purchased and begun using peanut balls and the nurses love them, and really believe they are making a difference. Nurses taking care of a mother laboring for a vaginal birth after cesarean used all of the tips and tricks they learned at the workshop and were able to help her have a VBAC. They have also been able to work on communicating with their physicians to provide more time to labor and successfully achieve vaginal births in situations that had previously ended up in cesareans.

Even the trainers learn new ideas from attendees at every workshop.  Have you ever used “Shake the Apple Tree” or the Walcher’s technique?  Even our trainers hadn’t until they began teaching these workshops! Now they spread new techniques across Florida so all can benefit from new tips and tricks to promote labor progress.

During discussion of the second stage, the evidence for and against laboring down, open glottis pushing, and position changes during pushing, are reviewed.  Have you ever tried pushing with a peanut ball, squat bar or used tug-o-war? We need to have many tools in our toolbox in order to support the physiology of birth!

Promoting both labor progress and comfort in labor with the use of the rebozo and birth ball

Why do most women not move around more in labor? Because they are connected to things! We end with a discussion on management of Category II fetal heart rate tracings and implementation of intermittent auscultation.  Despite the near universal adoption of continuous fetal monitoring, neonatal outcomes have not improved and cesarean section rates have risen drastically.  The evidence for and the technique for use of intermittent auscultation among low risk laboring individuals is reviewed.   

These workshops provide labor and birth providers with many strategies to improve the patient experience and health outcomes.  Feedback on these trainings has been overwhelmingly positive, with nurses enthusiastically telling us they were so glad they attended.

Please join us at our next workshop near you! www.fpqc.org/events




Written by Jessica Brumley, PhD, CNM and Emily Bronson, MA, MPH